Can Eating Disorders be Prevented?

I am reading a fascinating book. The title is terrific: The Emperor of All Maladies. The book is written by Siddhartha Mukherjee and was published by Scribner in 2010. I was listening to NPR one day, heard about it, and then listened to my own therapist tell me what a great book it is. So, I bought it.

Why do I write about it here? Because the book is a biography of cancer and about the very long journey the medical/science professions have endured to find a way to stop it or cure it or at least put it in remission.

I was recently reminded that whatever many of us parents are doing to help our loved one conquer ED, we are not using a cure necessarily, but rather a method. So, for example, I do not believe anyone has called Maudsley a "cure" but rather a "method." One goes "into residential treatment."   Eating disorders are complicated, not simple.

Keeping the word "method" in mind, and knowing that right now the very first step in treatment of an ED must be the cessation of the behavior that is driving the anorexia, the bulimia, the binge eating, EDNOS, exercising, etc, plus excellent nutrition,  there's still that elusive word "prevention" out there in the world of those researching these illnesses.

And preventive medicine in this country at least has taken a very long time to become acceptable.

I am about a little more than a third of my way through this terrifically written and engaging book. Drugs are being discussed, chemotherapy is on the rise, things like radical mastectomies are in decline, receptors have been found, and right now this reader has been taken into a philosophical discussion about mortality.

Mortality.... Here's a quote from the book:

 

"The only intervention ever known to reduce the aggregate mortality of a disease - any disease - at a population level was prevention."

And so far - understandably so - we parents are immersed in methods of treatment rather than of prevention in order to save our daughter's/son's life.

Meanwhile, I continue to be amazed at the numbers of teens who are being diagnosed with a brain disorder (I recently read 1 in 6). I continue to be amazed at the number of teens and younger children being diagnosed with the brain disorder anxiety.

Surely there is a link somewhere in here.  A recent study highlighted the possibility.

The brain of a growing individual keeps changing well into their twenties. So many things can go "right"; so many things can go "off path." Genetics plays an enormous part. Certain areas of the brain mature even more slowly than others. Nutrition is paramount. So is learning behaviors -- patterns if you will --  that keep one on the path to a productive life.

Suppose we all made a concerted effort to educate parents to take their children to the doctor for an assessment of their mental health as well as their physical health. "Teen Screen" is a start.

Perhaps this is one step towards prevention. There are others, too, like paying attention to family dynamics and communication for starters; like taking your child to the doctor when the child is having a difficult time coping. There's even talk now of being able to identify someone who might develop schizophrenia and treat them early enough so that potentially they don't go on to develop the disease.

Imagine if we could do that for those who are vulnerable to eating disorders??   I believe it's possible.

Guest Post on Defusing Spiraling Thought Patterns

 Marjie Ruth's latest post appeared shortly after I wrote my thoughts on expectations, possibilities and fantasies.  As I mentioned the other day, one of my tasks is to change the way I think.  Marjie has provided an excellent essay here on how to approach thoughts that for me can morph into frightening fantasies.  Perfect timing for me and hopefully for other readers, too.  I'm grateful to be on her mailing list!

Dear Friends & Families of the Eating Disordered,

I know that your life is probably very busy, but I hope you will remember that our group is still meeting and that in times of rush, pressure, and stress it is more important than ever to dedicate some time to taking care of yourself. And hopefully, you find the information from and time spent at the group meeting to be of support and encouragement. Our meeting this week will be on Weds (5/18) in Tampa at Hyde Park Counseling Center from 7 to about 8:30pm or so. Would love to have you there. Feel free to bring along anyone who might be interested. Please drop me a quick line if you think you will be attending.
The subject line for this email has to do with a section I read from a book called "Don't Sweat the Small Stuff...and its all small stuff", subtitle: Simple Ways to Keep the Little Things From Taking Over Your Life,  by Richard Carlson, PhD.  If you haven't read it, it's a great little handbook for reviewing and reshaping our thought patterns. It is broken down into 100 short topics with each taking only a few minutes to read. It's a good book to use for brief daily meditation. For example here is part of one such entry. I have taken the liberty of altering the original somewhat to be more on topic for our purposes. With acknowledgment to Dr Carlson and apologies for my liberties, my "alterations" are in italics:

Be Aware of the Snowball Effect of your Thinking

    A powerful technique for becoming more peaceful is to be aware of how quickly your negative and insecure thinking can spiral out of control. Have you ever noticed how uptight you feel when you're caught up in your thinking? And, to top it off, the more absorbed you get in the details of whatever is upsetting you, the worse you feel. One thought leads to another, and yet another, until at some point, you become incredibly agitated.
    For example, you might wake up in the middle of the night and find yourself thinking about something to do with your loved one's eating disorder. Maybe it was an OK day, but now one thought--a concern about a skipped meal, an angry conversation, perhaps an uncomfortable silence or unexplained avoidance--is just something that triggers an alarm response in you. And as you lay there in the dark you soon start to have that "Here we go again" feeling of slipping into a black hole of despair with no apparent way to get help. Your thoughts soon take you from a slammed door to a free-fall feeling of near panic. The night is dark and long, but a solution or cure seems to be slipping farther and farther away. Your mind starts racing from scenario to worse scenario. You find yourself bouncing between "what could we have done differently" to  "why does she (or he) have to put us through this" to "while I thought things were getting better, it seems it might only be worse than ever". You formulate and then discard one strategy after another. You try on different approaches to the problem, only to find fault with each one and feeling more and more like you are caught up in a totally impossible situation with no way out. For many people, there's no limit to how long this type of "thought attack" can go on. In fact, I've been told by clients that many of their days and nights are spent in this type of mental turmoil. Needless to say, it's impossible to feel peaceful with your head full of concerns and annoyances.
    The solution is to notice what's happening in your head before your thoughts have a chance to build any momentum. The sooner you catch yourself in the act of building your negative snowball, the easier it is to stop. In our example here, you might notice your snowball thinking right when you start focusing on the eating disorder and the things that make you fearful. Then, instead of obsessing about the why's, the what if's, and the how's of this horrible disease, you say to yourself, "Whew, there I go again," and consciously nip it in the bud. You stop your train of thought before it has a chance to get going. You can then focus, not on how overwhelmed you are, but on how grateful you are and this is where you need to fill in the blank. Perhaps your gratitude can be for that fact that however slow progress may seem, at least your loved one is involved in therapy. Or maybe you can be thankful that your loved one is feeling safe enough to express their anger. Or maybe just for something as simple as the fact that you both survived another day and tomorrow always brings new hope. Perhaps you can find some thankfulness in knowing that there is a support group that you can go to and talk over some of the things that trouble you, see that you are not the only one, and see that others have survived it. If you think of something that you feel you need to do in the morning, write it down and let it go until the morning.  You might even consider keeping a pen and paper by the bed for such moments.
    You may indeed be a very stressed person, but remember that filling your head with thoughts of how overwhelmed you are only exacerbates the problem by making you feel even more stressed than you already do. Try this simple little exercise the next time you begin to obsess. You'll be amazed at how effective it can be. You can cultivate the ability to defuse your own spiraling thought patterns. Discover the peace that comes through gratitude.

Marjie Ruth
727-244-9011(c)sruth1@tampabay.rr.com

Reflections on Expectations, Possibilities, and Fantasies

A year ago this month, I experienced something I'd never felt before -- overwhelming despair --  and knew I needed to do something about it.  About five months later, I wrote a post about my experience and what I chose to do.

I was faced with a similar situation this past Thursday evening.  My coping "tools" this time around include my husband who has taken the time to understand eating and brain disorders better and therefore has become an effective listener; my therapist and our continuing work on how I think and what I do about those thoughts; and the wonderful support group I'm so grateful to be a member of.

I raised the topic of expectations this morning and the thoughts that topic elicited from the group were nothing short of amazing.  We all walked away with such a variety of perspectives on the term without my needing to go into any personal detail at all.

One of the sayings I've come to respect is expectations breed resentments.  Before you, the reader, object and say that expectations are a good thing:  witness what we have learned to survive in this world is based on many expectations and also what happens in school systems when children are expected to succeed rather than to fail.   I agree with you.

But there are other kinds of expectations that lead me, at least, in the direction of oh no's (negative fantasy) automatically rather than oh boy's (positive fantasy).  I'm programmed, having been a witness to harmful behaviors for more than twenty years to expect the worst or at least to expect not so great an outcome  even though my own outcome was positive!!!!  (More on this soon when I finish reviewing Aimee Liu's new book titled Restoring Our Bodies, Reclaiming Our Lives).  So, when I learned about something my loved one had done, I was stunned because I had seen what this choice had done in the past and my mind leaped into the future with visions of dire consequences.

However, this year I also realized that I'd changed.  My mind, as I said, still leaped into a future fantasy.  However, I have come to understand at a much deeper level that I am not prescient.  And I know from my own experience and life that choices I've made in the past are no longer viable or healthy options for me so why should I assume that anyone else's choices will result in calamity rather than a learning experience with a positive outcome?

But, being a parent brings with it a deep connection with one's child(ren).  So this time, rather than sink into despair, I hovered between hanging on/seeing what will unfold and working my way into a different state of mind.  Both states are a development I did not think a year ago I would be able someday to reach.  And yet, here I am.

I'm sad, to tell the truth.  I feel afraid of that pain and potential grieving that I may face.  Actually, I'm living it today because I am grieving for the person who once upon a time didn't make such a harmful choice.  I am scared (but not to death) that the choice will grab hold again.  I also comprehend that there isn't anything I can do about it other than turn it over, detach with love, and pray that there's enough wisdom in my loved one now to avoid harm once the issue leading to the decision is addressed.  [N.B. I frequent Al-Anon meetings because six years ago I was unaware of a support group for eating disorders and I believed (still do) that the behaviors that become entrenched are similar to addictions.]

So, I'm going to continue to hang on to the concept of "possibilities" and work through the pain and fear that I'm feeling today.  Quien sabe?

Body, Mind, Spirit

Some years ago (actually in the 1970's)  the "Six Million Dollar Man" was a popular television show.  The series gave rise to "The Bionic Woman."  For those readers who weren't born yet, these series featured people who had what have now become more commonplace - artificial parts to replace or shore up our failing human biological components.  Nowadays, one can get implants or transplants for just about every part of the human body; an exaggeration, I know, but so often now we read of a new miracle of surgery and science.

My mother, had she lived a few more years, might soon have been able to see clearly again.  She lost her eyesight to the dry kind of macular degeneration and with the loss of her sight went her independence.  She soldiered on, as she put it, for a few years - until she turned 89 -  before she died after not surviving hip transplant surgery.  An artificial eye is on the horizon.  What a miracle that will be.

Any one of us now, given availability and more importantly insurance or a fortune or means to repay a loan, can get a tooth implant, a heart transplant, a liver transplant, and a new knee or hip, for example.  

One's teeth are covered by dental insurance, one's body is covered by medical insurance, in fact one's brain is covered by medical insurance, but the coverage of one's mind is at the whim of insurance companies or the government laws/legislatures.

Think about it.   Aren't your teeth part of your body?   I overheard someone speaking to my dentist this morning and he remarked he needed to return to his periodontist to be treated again at $20/minute.  One single tooth implant can cost upwards of $10,000 out of pocket  while a much larger and more complicated hip implant can cost you a relatively small copay if you have medical insurance.  If you suffer a stroke and are without insurance, you still can go to the hospital and get treatment that inevitably will be covered by some kind of insurance or absorbed by the hospital's financial machine (to its detriment).

But if you have a mental illness such as bipolar disorder or an eating disorder, good luck getting enough coverage or any treatment even if you have insurance with a mental health component so you don't have to go home prematurely (meaning before enough treatment is provided to reverse the effects of the disease) to die as someone I am somewhat electronically acquainted with put it recently.  

Aren't all of these organs from which these illnesses develop part of the human body?  Does it seem ridiculous to you as it does to me that there's no integrated insurance coverage to address all the ills of our bodies?  

Having studied anatomy and physiology in college, I became in awe of the interconnections of all parts of my body.  We spring from this tiny egg that is fertilized by a little sperm and eventually are born into this world with everything working correctly, if all goes well.  Beyond birth, our bodies are subjected to the vagaries of existence on this earth ranging from diet to shelter to opportunities.  

Yet when it comes to medicine, our bodies are splintered into parts that are addressed separately by members of the medical profession without regard to the fact that an abscess of a tooth can lead to death of the body, that dehydration and electrolyte imbalance can lead to death of the body, that a heart attack can lead to death of the body, that an infection from bacteria introduced to an opening in the skin when getting a transplant or implant or even a cut can lead to death of the body, that a imbalance of substances in the brain can lead to depression that can lead to suicide/the death of the body.

Read the above again.  Every single one of the things I've listed can and does happen to those with eating disorders.  Every single thing.  And yet our government of the people, by the people and for the people does not provide adequately for those who have a mental illness, even those who have insurance!!!!

And spirit?  What about spirit?  Wikipedia provides a rather broad definition of this term.  About three years ago I participated in a Family Week during which our group leader remarked that we are all spirits, if you think about it.  Our bodies are made up of molecules that are made up of particles that are in constant motion.  The body electric.  What happens over time to someone whose spirit is not nurtured, whose very being is maltreated or ignored.  Death.

Isn't it time to take a harder, more accepting look at  holistic medicine?

I think so.  I am angry that I need to go after these different facets to address and advocate for the well being of my loved one.  That one "side" won't work with the other "side" even though the basic team that meets includes all sides.  There's something wrong with our system.